By Madeline R. Vann, MPH

Medically Reviewed by Lindsey Marcellin, MD, MPH

When you have fibromyalgia, it may seem as if you just can’t get a break from the pain — which may include an aching back. As many as two-thirds of people with chronic low back pain also have fibromyalgia. Looking at the numbers from the other direction, up to 49 percent of people with fibromyalgia have lower back pain. In fact, back pain is so prevalent among people with fibromyalgia that it was once one of the symptoms doctors looked for in making a fibromyalgia diagnosis.

There’s no doubt that living with fibromyalgia is challenging enough on its own, let alone when you have back pain. But it may make you feel a little better to know there is an explanation for the intensity of the pain you’re going through.

“Both back pain and fibromyalgia belong to a group of disorders called central hypersensitivity syndromes,” says pain management specialist Ronald Staud, MD, professor of medicine at the University of Florida in Gainesville. Although the roots of the two conditions differ — for example, back pain could be caused by a damaged vertebral disk — the pain experiences of the two conditions bear some similarities. Among them is the sense that these chronic pain conditions cause you to be on a “high alert” setting of sorts (doctors call it hyperarousal). And then, to top it off, the pain wears you down, causing fatigue, depression, and anxiety that make living with fibromyalgia and back pain all the more draining.

“The hyperarousal is really a normal response,” says Dr. Staud. Normal, yes, but it throws a monkey wrench into finding the right combination of treatments to ease two very painful problems.

One essential is getting an accurate diagnosis of your back pain. According to Staud, many physicians who treat fibromyalgia can also assess back pain’s possible causes. However, ask for a referral to a pain specialist if you have any concerns about your doctor’s ability to parse out the factors contributing to your back pain and prescribe the appropriate medical treatment.

Treating Fibromyalgia and Back Pain

Pain medication is usually part of the prescription for fibromyalgia symptoms but often isn’t enough for most people, especially if a back condition is involved. Putting together a multipart pain plan is a must, says Staud. This is even more true if you need specific therapy for your back. Consider these additional ideas to create a comprehensive treatment strategy that may combine traditional and alternative approaches:

Lifestyle changes. Both back pain and fibromyalgia symptoms may improve as you work on a healthier lifestyle — adjusting your diet, increasing exercise, and losing weight if needed.

Mental health treatment. Anxiety, depression, and trouble sleeping can all make pain feel worse. Comprehensive treatment strategies may include therapy and medication targeted to depression and anxiety, says Staud.

Physical therapy. “Back pain is the mainstay of physical therapists,” says Staud. Physical therapists can teach you how to move through your day more effectively and show you stretches to ease back pain and perhaps make living with fibromyalgia easier.

Alternative treatment approaches. Acupuncture, biofeedback, and music therapy can help ease back pain. According to Staud, pain management specialists are well-versed in the complexity of pain treatment and will be open to any questions you might have about alternative approaches. Talking with your team about options you’re considering will also help you avoid any interactions between alternative treatments and prescription medications.

Education. Finally, a little knowledge can go a long way toward easing some of the anxiety you may be feeling. Talk with your medical team about the physiology of pain and the complex factors that influence your perception of pain when you are facing conditions related to hypersensitization.

When you’re struggling with low back pain and fibromyalgia, you might feel as though you’re fighting two battles. But a combination of therapies — some aimed at fibromyalgia, some aimed at the back pain, and some aimed at both — is more likely to bring you symptom relief.